Implantable renal replacement therapy device

ABSTRACT

An implantable renal replacement therapy device may include: a first catheter configured to be inserted into a blood vessel in a subject&#39;s body; a pump in fluid communication with the first catheter, the pump is configured to pump subject&#39;s blood from the blood vessel; a filter in fluid communication with the pump, the filter is configured to: receive the subject&#39;s blood from the pump, and filter the received blood to provide a filtered blood and a filtrate liquid, wherein the filter is in fluid communication with the first catheter to cause an outflow of the filtered blood from the filter to the blood vessel; and a second catheter in fluid communication with the filter and configured to be inserted into an urinary bladder in the subject&#39;s body to cause an outflow of the filtrate liquid from the filter to the urinary bladder.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.17/242,464 filed on Apr. 28, 2021, which is hereby incorporated byreference.

FIELD OF THE INVENTION

The present invention relates to the field of renal replacement therapydevices, and more particularly, to fully implantable renal replacementtherapy devices.

BACKGROUND OF THE INVENTION

Subjects suffering from end-stage renal diseases are typically requiredto undergo at least one of hemodialysis, peritoneal dialysis orcontinuous renal replacement therapy treatments while waiting for kidneytransplantation. However, these treatments may cause significantinconvenience to a subject. For example, subjects undergoinghemodialysis treatment are required to attend a treatment facility atleast three times a week for several hours each time.

SUMMARY OF THE INVENTION

Some embodiments of the present invention may provide an implantablerenal replacement therapy device, the device may include: a firstcatheter configured to be inserted into a blood vessel in a subject'sbody; a pump in fluid communication with the first catheter, the pump isconfigured to pump subject's blood from the blood vessel; a filter influid communication with the pump, the filter is configured to: receivethe subject's blood from the pump, and filter the received blood toprovide a filtered blood and a filtrate liquid, wherein the filter is influid communication with the first catheter to cause an outflow of thefiltered blood from the filter to the blood vessel; and a secondcatheter in fluid communication with the filter and configured to beinserted into an urinary bladder in the subject's body to cause anoutflow of the filtrate liquid from the filter to the urinary bladder.

In some embodiments, the first catheter may include: a first lumen influid communication with the pump; and a second lumen in fluidcommunication with the filter.

In some embodiments, the first catheter may include a first catheterconnector configured to connect the first catheter to the blood vesseland to prevent motion of the first catheter with respect to the bloodvessel.

In some embodiments, the first catheter connector may include: a firstinflatable member connected to an outer surface of the first catheter;and a second inflatable member connected to the outer surface of thefirst catheter at a predefined first distance from the first inflatablemember and a predefined second distance from a distal sharp end of thefirst catheter; wherein, when inflated, the first and second inflatablemembers are configured to receive a wall of the blood vesseltherebetween to prevent motion of the first catheter with respect to theblood vessel.

In some embodiments, the pump is an axial or centrifugal flow pump.

In some embodiments, the filter has a substantially flat flexiblestructure.

In some embodiments, the filter has a substantially flat and thinflexible structure, having a uniform thickness substantially smallerthan a width or length of the filter.

In some embodiments, the filter may include: a filtrate collecting bagin fluid communication with the second catheter; and a filteringmembrane positioned within the filtrate collecting bag, the filteringmembrane having filtering membrane interior in fluid communication withthe pump and configured to receive the subject's blood from the pump.

In some embodiments, the filtering membrane may be made of a siliconeand may include a plurality of pores having high permeability forselected liquids and selected electrolytes.

In some embodiments, the filtering membrane has a wavy structure in itscross-section.

In some embodiments, the filter may further include a second membranesurrounding the filtering membrane, the second membrane having lowerpermeability for the selected liquids and the selected electrolytes ascompared to the permeability of the filtering membrane to causereabsorption of excess liquids of the selected liquids and excesselectrolytes of the selected electrolytes within the filtered blood.

In some embodiments, the filter may include a conduit for injection ofliquids into the filter, wherein the conduit is configured to extendexternal to the subject's body.

In some embodiments, the second catheter may include an adjustable ringconfigured to adjust a diameter of the second catheter based on adesired blood filtration rate and a desired filtrate outflow rate.

In some embodiments, the second catheter may include a second catheterconnector configured to connect the second catheter to the urinarybladder and to prevent motion of the second catheter with respect to theurinary bladder.

In some embodiments, the second catheter connector may include: a firstinflatable member connected to an outer surface of the second catheter;and a second inflatable member connected to the outer surface of thesecond catheter at a predefined first distance from the first inflatablemember and a predefined second distance from a distal sharp end of thesecond catheter; wherein, when inflated, the first and second inflatablemembers are configured to receive a wall of the urinary bladdertherebetween to prevent motion of the second catheter with respect tothe urinary bladder.

In some embodiments, the device may include a power source configured tobe implanted in the subject's body to provide power to the pump.

In some embodiments, the power source is chargeable.

In some embodiments, the power source is wirelessly chargeable.

In some embodiments, the device may further include an externalnon-implantable power source to at least one of: (i) provide power tothe pump, and (ii) charge a power source that provides power to thepump.

In some embodiments, the device may further include one or more sensorsconfigured to be implanted in the subject's body and measure one or moreproperties of at least one of the subject's blood and subject's bloodfiltration work products.

In some embodiments, the device may further include a controllerconfigured to: receive the one or more measured properties from the oneor more sensors; and control a pump rate or speed of the pump based onthe one or more measured properties and a desired filtration rate of thesubject's blood.

In some embodiments, the controller is configured to generate one ormore notifications based on the one or more measured properties.

These, additional, and/or other aspects and/or advantages of the presentinvention are set forth in the detailed description which follows;possibly inferable from the detailed description; and/or learnable bypractice of the present invention.

BRIEF DESCRIPTION OF THE DRAWINGS

For a better understanding of embodiments of the invention and to showhow the same can be carried into effect, reference will now be made,purely by way of example, to the accompanying drawings in which likenumerals designate corresponding elements or sections throughout.

In the accompanying drawings:

FIG. 1A is a schematic illustration of an implantable renal replacementtherapy device, according to some embodiments of the invention;

FIGS. 1B and 1C are schematic illustrations of an implantable renalreplacement therapy device, implanted in a subject's body, according tosome embodiments of the invention;

FIGS. 2A and 2B are schematic illustrations of a first catheter of animplantable renal replacement therapy device, according to someembodiments of the invention;

FIG. 2C is a schematic illustration of a first catheter inserted into ablood vessel, according to some embodiments of the invention;

FIGS. 3A and 3B are schematic illustrations of a filter of animplantable renal replacement therapy device, according to someembodiments of the invention;

FIGS. 4A and 4B are schematic illustrations of a second catheter of animplantable renal replacement therapy device, according to someembodiments of the invention;

FIG. 4C is a schematic illustration of a second catheter of animplantable renal replacement therapy device, inserted into a urinarybladder, according to some embodiments of the invention; and

FIG. 5 is a schematic illustration of an implantable renal replacementtherapy device, a subject's body and incisions to be made in thesubject's body in order to implant the implantable renal replacementtherapy device, according to some embodiments of the invention.

It will be appreciated that, for simplicity and clarity of illustration,elements shown in the figures have not necessarily been drawn to scale.For example, the dimensions of some of the elements may be exaggeratedrelative to other elements for clarity. Further, where consideredappropriate, reference numerals may be repeated among the figures toindicate corresponding or analogous elements.

DETAILED DESCRIPTION OF THE INVENTION

In the following description, various aspects of the present inventionare described. For purposes of explanation, specific configurations anddetails are set forth in order to provide a thorough understanding ofthe present invention. However, it will also be apparent to one skilledin the art that the present invention can be practiced without thespecific details presented herein. Furthermore, well known features canhave been omitted or simplified in order not to obscure the presentinvention. With specific reference to the drawings, it is stressed thatthe particulars shown are by way of example and for purposes ofillustrative discussion of the present invention only and are presentedin the cause of providing what is believed to be the most useful andreadily understood description of the principles and conceptual aspectsof the invention. In this regard, no attempt is made to show structuraldetails of the invention in more detail than is necessary for afundamental understanding of the invention, the description taken withthe drawings making apparent to those skilled in the art how the severalforms of the invention can be embodied in practice.

Before at least one embodiment of the invention is explained in detail,it is to be understood that the invention is not limited in itsapplication to the details of construction and the arrangement of thecomponents set forth in the following description or illustrated in thedrawings. The invention is applicable to other embodiments that can bepracticed or carried out in various ways as well as to combinations ofthe disclosed embodiments. Also, it is to be understood that thephraseology and terminology employed herein is for the purpose ofdescription and should not be regarded as limiting.

Reference is now made to FIG. 1A, which is a schematic illustration ofan implantable renal replacement therapy device 100, according to someembodiments of the invention.

Reference is also made to FIGS. 1B and 1C, which are schematicillustrations of an implantable renal replacement therapy device 100,implanted in a subject's body 90, according to some embodiments of theinvention.

According to some embodiments of the invention, device 100 may include afirst catheter 110, a pump 120, a filter 130 and a second catheter 140.Device 100 may be configured to be fully implanted in subject's body 90.Device 100 may be fully implanted in subject's body 90 such that none ofits components protrudes from subject's body 90. For example, device 100may be configured to be implanted in subject's body 90 between abdominalwall muscles and a transversalis fascia.

First catheter 110 may be configured to be inserted into a blood vessel92. In some embodiments, first catheter 110 may be a venous catheterconfigured to be inserted into a central vein (e.g., as schematicallyshown in FIGS. 1B and 1C). One embodiment of first catheter 110 isdescribed below with respect to FIGS. 2A, 2B and 2C. However, otherembodiments of first catheter 110 are possible.

Pump 120 may be in fluid communication with first catheter 110. Pump 120may be configured to pump subject's blood from blood vessel 92. In someembodiments, pump 120 may be an axial flow pump. In some embodiments,pump 120 may be a centrifugal flow pump. In some embodiments, pump 120may have a displacement volume of 15-25 ml (e.g., 20 ml). In someembodiments, pump 120 may have a weight of 60-100 gr (e.g., 80 gr). Insome embodiments, pump 120 may include a single impeller rotatablysupported within a cylindrical tube. In some embodiments, pump 120 mayhave a length of 4-6 cm (e.g., 5 cm). In some embodiments, pump 120 mayhave an outer diameter of 1-2 cm (e.g., 1.5 cm). In some embodiments,pump 120 may be configured to create high hydrostatic pressure withinfilter 130. Pump 120 may be configured to generate filtrate in aproduction rate of 30-100 ml/hour (e.g., 50 ml/hour). Pump 120 may beconfigured to generate blood flow of 100-300 ml/minute (e.g., 150ml/minute).

Filter 130 may be in fluid communication with pump 120. Filter 130 maybe configured to receive the subject's blood being pumped by pump 120.Filter 130 may be configured to filter the received subject's blood toprovide a filtered blood and a filtrate liquid. Filter 130 may be influid communication with first catheter 110 to cause an outflow of thefiltered blood from filter 130 to blood vessel 92. Filter 130 may bethin and flat, having a uniform thickness substantially smaller than awidth or length of the filter. For example, a thickness of filter 130may be 3 times, 5 times, or 10 times or more smaller than a width and alength of filter 130. For example, filter 130 may have a length of 10-15cm (e.g., 12 cm), a width of 5-15 cm (e.g., 10 cm) and a thickness of1-3 cm (e.g., 2 cm). In some embodiments, filter 130 may be made offlexible materials. One embodiment of filter 130 is described below withrespect to FIGS. 3A and 3B. However, other embodiments of filter 130 arepossible.

Second catheter 140 may be in fluid communication with filter 130.Second catheter 140 may be configured to be inserted into a subject'surinary bladder 94 to cause an outflow of the filtrate liquid fromfilter 130 to urinary bladder 94. One embodiment of second catheter 140is described below with respect to FIGS. 4A, 4B and 4C. However, otherembodiments of second catheter 140 are possible.

In some embodiments, device 100 may include a power source 150. Powersource 150 may provide power to pump 120. In some embodiments, powersource 150 may be configured to be implanted in subject's body 90 (e.g.,as shown in FIGS. 1B and 1C). For example, power source 150 may beconfigured to be fully implanted in subject's body 90 (e.g., such thatnone of its components protrudes external to subject's body 90). In someembodiments, power source 150 may be chargeable. For example, powersource 150 may be wirelessly chargeable.

In some embodiments, device 100 may include an external power source152. In some embodiments, external power source 152 is not implantable.In some embodiments, external power source 152 may be configured to befastened to subject's body 90 (e.g., as schematically shown in FIGS. 1Band 1C). For example, external power source 152 may include one or morefasteners configured to fasten external power source 152 to subject'sbody (not shown). In some embodiments, external power source 152 may beconfigured to provide power to pump 120. In some embodiments, externalsource 152 may be configured to charge power source 150. In someembodiments, external power source 152 may be connected to pump 120using a flexible driveline 152 a configured to extend external tosubject's body 90 (e.g., as shown in FIGS. 1B and 1C).

In some embodiments, device 100 may include of one or more sensors 160.One or more sensors 160 may be configured to measure one or moreproperties of the subject's blood and/or of the subject's bloodfiltration work products. For example, one or more sensors 160 maymeasure a concentration of electrolytes in the subject's blood, aconcentration of ions in the subject's blood, a filtration rate of thesubject's blood, an amount of the filtered blood being produced byfilter 130, an amount of the filtrated liquid being produced by filter130, a flow rate of the subject's blood through device 100, etc. In someembodiments, one or more sensors 160 may be configured to be implantedin subject's body 90. For example, one or more sensors 160 may beconfigured to be fully implanted in subject's body 90 (e.g., such thatnone of its components protrudes external to subject's body 90). One ormore sensors 160 may be positioned, for example, within and/or on firstcatheter 110, filter 130, second catheter 140, etc. Some examples ofpossible positions of one or more sensors 160 are schematically shown inFIG. 1. However, other positions of one or more second filters 160 arepossible.

In some embodiments, device 100 may include a controller 170. In someembodiments, controller 170 may be configured to be implanted insubject's body 90 (e.g., as schematically shown in FIG. 1B). Forexample, controller 170 may be configured to be fully implanted insubject's body 90 (e.g., such that none of its components protrudesexternal to subject's body 90). In some embodiments, controller 170 maybe connected to external power source 152 using a flexible driveline 170a configured to extend external to subject's body 90 (e.g., asschematically shown in FIG. 1B).

In some embodiments, controller 170 is not implantable. In someembodiments, controller 170 may be configured to be fastened tosubject's body 90 (e.g., as schematically shown in FIG. 1C). Forexample, controller 170 may include one or fasteners configured tofasten controller 170 to subject's body (not shown). In someembodiments, controller 170 may be connected to pump 120 using aflexible driveline 170 b configured to extend external to subject's body90 (e.g., as shown in FIG. 1C).

Controller 170 may be in communication (e.g., wired or wireless) withone or more sensors 160. Controller 170 may receive the one or moremeasured properties from one or more sensors 160. In some embodiments,controller 170 may control a pump rate of pump 120 based on the one ormore measured properties and a preset/desired filtration rate of thesubject's blood. For example, controller 170 may implement a machinelearning algorithm configured to receive as an input the one or moremeasured properties, output the required pump rate and control pump 120according to the required pump rate. In some embodiments, controller 170may generate one or more notifications based on the one or more measuredproperties. For example, controller 170 may generate a notificationalert if at least one of the one or more measured properties is notwithin a predefined range. Controller 170 may transmit the one or morenotifications to an external computing device. The external computingdevice may include at least one of a smartphone (for example belongingto the subject), a personal computer (for example of a treatinghealthcare professional), and a server (for example of a healthcarefacility). In some embodiments, controller 170 may transmit the one ormore measured properties to the external computing device for furtheranalysis.

In some embodiments, controller 170 may monitor one or more operationalparameters of device 100. For example, controller 170 may monitor thepump rate or speed of pump 120, a charging level of power source 150,etc. In some embodiments, controller 170 may generate one or morenotifications based on the one or more monitored operational parameters.For example, controller 170 may generate a notification alert if themeasured operational parameters indicate that the charging level ofpower source 150 is below a predefined charging level threshold and/orthat the pump rate of pump 120 is below a predefined pump ratethreshold, etc. In some embodiments, controller 170 may transmit the oneor more notifications to the external computing device.

Reference is now made to FIGS. 2A and 2B, which are schematicillustrations of a first catheter 110 of an implantable renalreplacement therapy device 100, according to some embodiments of theinvention.

Reference is also made to FIG. 2C, which is a schematic illustration ofa first catheter 110 inserted into a blood vessel 92, according to someembodiments of the invention.

According to some embodiments of the invention, first catheter 110 maybe a dual-lumen catheter and may include a first lumen 112 and a secondlumen 114. First lumen 112 of first catheter 110 may be connected topump 120. Second lumen 114 of first catheter 110 may be connected tofilter 130.

In some embodiments, first catheter 110 may include a first catheterconnector 116. First catheter connector 116 may be configured to connectfirst catheter 110 to blood vessel 92. In some embodiments, firstcatheter connector 116 may be configured to connect first catheter 110to blood vessel 92 and to prevent motion of first catheter 110 withrespect to blood vessel 92.

In some embodiments, first catheter connector 116 may include a firstinflatable member 116 a and a second inflatable member 116 b. Firstinflatable member 116 a and second inflatable member 116 b may beconnected to an outer surface 117 of first catheter 110 at a predefineddistance 116 c with respect to each other. First inflatable member 116 aand second inflatable member 116 b may be connected to first catheter110 at a predefined distance from a distal sharped end 118 of firstcatheter 110. For example, the distance between second inflatable member116 b and distal sharp end 118 of first catheter 110 may range between0.5-1 cm. In some embodiments, an outer diameter of first catheter 110may range between 0.5-0.8 cm. In some embodiments, first catheter 110may include two fluid conduits each for providing a pressurized fluid toone of first inflatable member 116 a and second inflatable member 116 bfor inflating and deflating the respective inflatable member. Wheninflated, first inflatable member 116 a and second inflatable member 116b may be configured to receive a wall 92 a of blood vessel 92therebetween to prevent motion of first catheter 110 with respect toblood vessel 92 (e.g., as shown in FIG. 2C).

First inflatable member 116 a and second inflatable member 116 bpositioned adjacent to distal sharp end 118 of first catheter 110 mayensure safe and stable connection of first catheter 110 to blood vessel92 while requiring only a short section of first catheter 110 to beinserted into blood vessel 92. Having short section of first catheter110 within blood vessel 92 may significantly reduce catheter-associatedcomplications in blood vessel 92 (for example, thrombosis and infection)as compared to catheters that require relatively long sections thereofto be inserted into the blood vessel.

Reference is now made to FIGS. 3A and 3B, which are schematicillustrations of a filter 130 of an implantable renal replacementtherapy device 100, according to some embodiments of the invention.

FIG. 3A shows a schematic sectional view AA and FIG. 3B shows aschematic cross-sectional view BB of filter 130.

According to some embodiments of the invention, filter 130 may include afiltrate liquid collecting bag 132 and a filtering membrane 134.

Filtrate liquid collecting bag 132 may receive the filtrated liquid.Filtering liquid collecting bag 132 may be in fluid communication withsecond catheter 140 to cause an outflow of the filtrate liquid fromfiltering liquid collecting bag 132 to urinary bladder 94 through secondcatheter 140.

Filtering membrane 134 may be positioned within filtrate liquidcollecting bag 132. Filtering membrane 134 may have a filtering membraneinterior 134 a in fluid communication with pump 120. Filtering membraneinterior 134 a may be adapted to receive the subject's blood from pump120.

In some embodiments, filtering membrane 134 may be made of a silicone.Filtering membrane 134 may include a plurality of pores having highpermeability for selected liquids and selected electrolytes that need tobe filtered from the subject's blood. For example, the substances thatneed to be filtered from the subject's blood may include urea,creatinine, potassium, hydrogen, uric acid, etc. In some embodiments,the pores in filtering membrane 134 may be nanopores. In someembodiments, the pores in filtering membrane 134 may have uniform (orsubstantially uniform) size. The uniform nanopores of filtering membrane134 may, for example, reduce hydraulic resistance of filtering membrane134 while maintaining molecular selectivity of filtering membrane 134.In some embodiments, the pores in filtering membrane 134 may have anelongated shape in the form of a slit. For example, slit-shapednanopores of filtering membrane 134 may reduce hydraulic resistance offiltering membrane 134. In some embodiments, filtering membrane 134 maybe electrically charged. In some embodiments, a surface of filteringmembrane 134 may be modified using polyethylene glycol (PEG).Modification of the surface of filtering membrane 134 with PEG may, forexample, reduce fouling filtering membrane 134 by globular proteins.

In some embodiments, filter 130 may include a second membrane 136.Second membrane 136 may surround filtering membrane 134. In someembodiments, second membrane 136 may have lower permeability for theselected liquids and the selected electrolytes than the filteringmembrane 134. Accordingly, second membrane 136 may prevent excess liquidof the selected liquids and excess electrolyte of the selectedelectrolytes, which passed through filtering membrane 134, from passingthrough second membrane 136, thus causing reabsorption of the excessliquids and the excess electrolytes within the filtered blood. Forexample, the substances that need to be reabsorbed within the filteredblood may include water (e.g., up to 95% of water), and Na⁺, K⁺, Ca²⁺,Mg²⁺, HCO³⁻, Cl⁻, etc. In some embodiments, second membrane 136 may havea plurality of pores. In various embodiments, the pores of secondmembrane 136 may have different shape and/or size as compared to poresof filtering membrane 134. In some embodiments, second membrane 136 maybe electrically charged. In some embodiments, the electrical charge ofsecond membrane 136 may be different as compared to the electricalcharge of filtering membrane 134.

In some embodiments, second membrane 136 may be covered with renaltubular cells. For example, samples of subject's omental tissue may beobtained which may be then reprogrammed to become pluripotent stemcells. The pluripotent stem cells may be then differentiated into renaltubular cells. The renal tubular cells may be processed intopersonalized subject-specific hydrogel which may be used together withextracellular matrix and endothelial cells to form a bio ink forthree-dimensional printing of a living functioning patch of renaltubular cells. The renal tubular cells may be then used to cover secondmembrane 136.

In various embodiments, filtering membrane 134 and/or second membrane136 may have a wavy structure in their respective cross-section (e.g.,as schematically shown in FIG. 3B). Arranging the membranes in the wavystructure may increase a filtering surface of the membranes as comparedto membranes having non-wavy structure.

A thickness of filter 130 may be significantly smaller than a widthand/or a length of filter 130. For example, filter 130 may have a lengthof 10-15 cm (e.g., 12 cm), a width of 5-15 cm (e.g., 10 cm) and athickness of 1-3 cm (e.g., 2 cm).

In some embodiments, filter 130 may include a conduit 138. Conduit 138may be configured to extend external to subject's body 90. Conduit 138may be used for direct injection of liquids and drugs into filter 130for cleaning filter 130. For example, thrombolytic drugs may be injectedinto filter 130 via conduit 138 to clean blood clots from filter 130. Insome embodiments, conduit 138 may be in fluid communication with a gap136 a between filtering membrane 134 and second membrane 136 of filter130.

Reference is now made to FIGS. 4A and 4B, which are schematicillustrations of a second catheter 140 of an implantable renalreplacement therapy device 100, according to some embodiments of theinvention.

Reference is also made to FIG. 4C, which is a schematic illustration ofa second catheter 140 of an implantable renal replacement therapy device100, inserted into an urinary bladder 94, according to some embodimentsof the invention.

According to some embodiments of the invention, second catheter 140 mayinclude a second catheter connector 142. Second catheter connector 142may be configured to connect second catheter 140 to urinary bladder 94.In some embodiments, second catheter connector 142 may be configured toconnect second catheter 140 to urinary bladder 94 and to prevent motionof second catheter 140 with respect to urinary bladder 94.

In some embodiments, second catheter connector 142 may include a firstinflatable member 142 a and a second inflatable member 142 b. Firstinflatable member 142 a and second inflatable member 142 b may beconnected to an outer surface 143 of second catheter 140 at a predefineddistance 142 c with respect to each other. First inflatable member 142 aand second inflatable member 142 b may be connected to second catheter140 at a predefined distance from a distal sharp end 144 of secondcatheter 140. For example, the distance between second inflatable member142 b and distal sharp end 144 of second catheter 140 may range between1-2 cm. In some embodiments, second catheter 140 may include two fluidconduits each for providing a pressurized fluid to one of firstinflatable member 142 a and second inflatable member 142 b for inflatingand deflating the respective inflatable member. When inflated, firstinflatable member 142 a and second inflatable member 142 b may beconfigured to receive a wall 94 a of urinary bladder 94 therebetween toprevent motion of second catheter 140 with respect to urinary bladder(e.g., as shown in FIG. 4C).

In some embodiments, second catheter 140 may include an adjustable ring146 to adjust a diameter of second catheter 140. For example, adjustablering may be connected to outer surface 143 of second catheter 140, e.g.,adjacent to a proximal end 147 of second catheter 140 at which secondcatheter 140 is connected to filter 130. The diameter of second catheter140 may be adjusted using adjustable ring 146, for example during and/orafter implantation of device 100, based on, e.g., a desired filtrationrate of the subject's blood and/or based on a desired outflow of thefiltrate liquid from filter 130. In some embodiments, adjustable ring146 may be inflatable. In some embodiments, adjustable ring 146 mayinclude a fluid conduit for providing a pressurized fluid to adjustablering 146 for inflating and deflating adjustable ring 146 (not shown).

Reference is now made to FIG. 5, which is a schematic illustration of animplantable renal replacement therapy device 100, subject's body 90 andincisions 201-204 to be made in subject's body 90 in order to implantthe implantable renal replacement therapy device 100, according to someembodiments of the invention.

Implantable renal replacement therapy device 100 may be fully implantedin subject's body 90 such that none of its components protrudes fromsubject's body 90. For example, device 100 may be implanted in subject'sbody 90 between abdominal wall muscles a transversalis fascia membrane.Device 100 may be implanted in a safe superficial procedure, withoutpenetrating into an abdominal cavity of subject's body 90 and withoutperforming any arterial manipulations in subject's body 90.

One example of an implantation procedure of device 100 in subject's body90 is described herein with respect to FIG. 5. It is noted that theimplantation procedure is not limited to the illustrations in FIG. 5 andto the corresponding description. For example, the implantationprocedure need not necessarily include each described step, or inexactly the same order as described. It is also noted that otherimplantation procedures of device 100 are possible.

A first incision 201 (e.g., 2 cm incision) may be made in subject's body90 at a groin, above a femoral vein and the femoral vein may be exposed.A second incision 202 (e.g., 1 cm incision) may be made in subject'sbody 90 at a lower abdomen, above the inguinal ligament. First catheter110 of device 100 may be tunneled (e.g., subcutaneously) from the lowerabdomen to the groin. First catheter 110 may be inserted into thefemoral vein (e.g., using a Seldinger technique that includes aninsertion of a catheter over a wire) and secured to the femoral veinusing first catheter connector 116 (e.g., as described above withrespect to FIG. 2C). In some cases, a purse-string stitch (e.g., havinga diamond shape) may be made to further secure first catheter 110catheter to the femoral vein. First catheter 110 may be then washed withblood and first incision 201 above the femoral vein may be closed (e.g.,in layers).

A third incision 203 (e.g., 5 cm longitudinal incision) may be made insubject's body 90 at a lateral abdominal wall, and a plane betweenabdominal wall muscles and transversalis fascia may be dissected. Firstcatheter 110 may be tunneled to the dissected plane and first lumen 112may be connected to an inlet of pump 120. An outlet of pump 120 may beconnected to an inlet of filter 130. An outlet of filter 130 may beconnected to second lumen 114 of first catheter 110. Second incision 202at the lower abdomen may be closed.

A fourth incision 204 (e.g., 2 cm suprapubic incision) in subject's body90 may be made directly above urinary bladder 94 (e.g., under ultrasoundguiding). Second catheter 140 may be inserted to urinary bladder 94,secured to urinary bladder 94 using second catheter connector 142, andtunneled and connected to filter 130 (e.g., to collecting bag 132).Fifth substantially circular incision 205 (e.g., 0.5 cm incision) may bemade, for example laterally to third incision 203, for tunnellingdrivelines (e.g., drivelines 152 a/170 a/170 b described hereinabove)external to subject's body 90. Fourth incision 204 may be closed. Thirdincision 203 may be closed. Device 100 may be turned on.

The disclosed implantable renal replacement therapy device may provide acontinuous renal replacement therapy for a subject while maintaining thesubject's ability to perform normal daily activities including normalurination. The device may be implanted in the subject's body betweenabdominal wall muscles a transversalis fascia membrane in a simple andsafe superficial procedure, without penetrating into an abdominal cavityof the subject's body and without performing any arterial manipulationsin the subject's body. The superficial procedure may avoid (or at leastsignificantly reduce) abdominal complications associated withintra-abdominal implantations. The superficial implantation may providesafe and minimally invasive access to the implanted device, for examplein the case of post-implantation malfunctions and/or complications.Absence of arterial manipulations during implantation of the device mayeliminate possible life-threatening arterial complications associatedwith arterial manipulations procedures. Flexible and flat filter (e.g.,thin and flat filter, having a uniform thickness substantially smallerthan a width or length of the filter) of the device may significantlyreduce the complexity of its implantation and significantly reduceinconvenience and lifestyle limitations that may be caused thereby.

In the above description, an embodiment is an example or implementationof the invention. The various appearances of “one embodiment”, “anembodiment”, “certain embodiments” or “some embodiments” do notnecessarily all refer to the same embodiments. Although various featuresof the invention can be described in the context of a single embodiment,the features can also be provided separately or in any suitablecombination. Conversely, although the invention can be described hereinin the context of separate embodiments for clarity, the invention canalso be implemented in a single embodiment. Certain embodiments of theinvention can include features from different embodiments disclosedabove, and certain embodiments can incorporate elements from otherembodiments disclosed above. The disclosure of elements of the inventionin the context of a specific embodiment is not to be taken as limitingtheir use in the specific embodiment alone. Furthermore, it is to beunderstood that the invention can be carried out or practiced in variousways and that the invention can be implemented in certain embodimentsother than the ones outlined in the description above.

The invention is not limited to those diagrams or to the correspondingdescriptions. For example, flow need not move through each illustratedbox or state, or in exactly the same order as illustrated and described.Meanings of technical and scientific terms used herein are to becommonly understood as by one of ordinary skill in the art to which theinvention belongs, unless otherwise defined. While the invention hasbeen described with respect to a limited number of embodiments, theseshould not be construed as limitations on the scope of the invention,but rather as exemplifications of some of the preferred embodiments.Other possible variations, modifications, and applications are alsowithin the scope of the invention. Accordingly, the scope of theinvention should not be limited by what has thus far been described, butby the appended claims and their legal equivalents.

1. An implantable renal replacement therapy device, the devicecomprising: a first catheter configured to be inserted into a bloodvessel in a subject's body; a pump in fluid communication with the firstcatheter, the pump is configured to pump subject's blood from the bloodvessel; a flexible flat filter in fluid communication with the pump, theflexible flat filter is configured to: receive the subject's blood fromthe pump, and filter the received blood to provide a filtered blood anda filtrate liquid, wherein the flexible flat filter is in fluidcommunication with the first catheter to cause an outflow of thefiltered blood from the flexible flat filter to the blood vessel; and asecond catheter in fluid communication with the flexible flat filter andconfigured to be inserted into a urinary bladder in the subject's bodyto cause an outflow of the filtrate liquid from the flexible flat filterto the urinary bladder; wherein at least the flexible flat filter isconfigured to be implanted in the subject's body between abdominal wallmuscles and a transversalis fascia membrane of the subject's body. 2.The device of claim 1, comprising a conduit for injection of liquidsinto flat flexible filter, the conduit is configured to extend externalto the subject's body.
 3. The device of claim 1, wherein the flatflexible filter comprises a filtering membrane having a permeability forselected liquids and selected electrolytes, the filtering membranecomprises a filtering membrane interior in fluid communication with thepump and configured to receive the subject's blood from the pump.
 4. Thedevice of claim 3, wherein the filtering membrane comprises siliconematerial.
 5. The device of claim 3, wherein the filtering membranecomprises a plurality of slit-shaped nanopores.
 6. The device of claim3, wherein the filtering membrane has a wavy structure in itscross-section.
 7. The device of claim 3, wherein the flat flexiblefilter comprises a filtrate collecting bag surrounding the filteringmembrane and configured to receive the filtrate liquid, the filtratecollecting bag is in fluid communication with the second catheter. 8.The device of claim 3, wherein the filter further comprises a secondmembrane positioned within the filtrate collecting bag and surroundingthe filtering membrane.
 9. The device of claim 8, wherein the secondmembrane having lower permeability for the selected liquids and theselected electrolytes as compared to the permeability of the filteringmembrane to cause reabsorption of excess liquids of the selected liquidsand excess electrolytes of the selected electrolytes within the filteredblood.
 10. The device of claim 9, wherein the second membrane is coveredwith programed pluripotent stem cells, differentiated into living andfunctioning patches of renal tubular cells.
 11. The device of claim 9,wherein the second membrane surrounds the filtering membrane such that agap is formed between the second membrane and the filtering membrane.12. The device of claim 11, comprising a conduit for injection ofliquids into the gap between the second membrane and the filteringmembrane, the conduit is configured to extend external to the subject'sbody.
 13. The device of claim 1, comprising a first catheter connectorconnected to the first catheter at a distance from a distal sharped endof the first catheter, the first catheter connector is configured, whenactuated, to embrace a portion of a wall of the blood vessel to preventmotion of the first catheter with respect to the blood vessel.
 14. Thedevice of claim 1, comprising a second catheter connector connected tothe second catheter at a distance from a distal sharped end of thesecond catheter, the second catheter connector is configured, whenactuated, to embrace a portion of a wall of the urinary bladder toprevent motion of the second catheter with respect to the urinarybladder.
 15. The device of claim 1, wherein the second cathetercomprises an adjustable ring configured to adjust a diameter of thesecond catheter based on a desired blood filtration rate and a desiredfiltrate outflow rate.
 16. An implantable renal replacement therapydevice, the device comprising: a first catheter having a distal sharpend configured to be inserted into a blood vessel in a subject's body; afirst catheter connector connected to the first catheter at a distancefrom the distal sharped end of the first catheter, the first catheterconnector is configured, when actuated, to embrace a portion of a wallof the blood vessel to prevent motion of the first catheter with respectto the blood vessel; a pump in fluid communication with the firstcatheter, the pump is configured to pump subject's blood from the bloodvessel; a filter in fluid communication with the pump, the filter isconfigured to: receive the subject's blood from the pump, and filter thereceived blood to provide a filtered blood and a filtrate liquid,wherein the filter is in fluid communication with the first catheter tocause an outflow of the filtered blood from the filter to the bloodvessel; and a second catheter in fluid communication with the filter andconfigured to be inserted into a urinary bladder in the subject's bodyto cause an outflow of the filtrate liquid from the filter to theurinary bladder.
 17. The device of claim 16, wherein the first catheterconnector comprises: a first inflatable member connected to an outersurface of the first catheter; and a second inflatable member connectedto the outer surface of the first catheter at a first distance from thefirst inflatable member and a second distance from a distal sharp end ofthe first catheter; wherein, when inflated, the first and secondinflatable members are configured to receive a wall of the blood vesseltherebetween to prevent motion of the first catheter with respect to theblood vessel.
 18. The device of claim 16, comprising a second catheterconnector connected to the second catheter at a distance from a distalsharped end of the second catheter, the second catheter connector isconfigured, when actuated, to embrace a portion of a wall of the urinarybladder to prevent motion of the second catheter with respect to theurinary bladder.
 19. The device of claim 16, wherein the second catheterconnector comprises: a first inflatable member connected to an outersurface of the second catheter; and a second inflatable member connectedto the outer surface of the second catheter at a predefined firstdistance from the first inflatable member and a predefined seconddistance from a distal sharp end of the second catheter; wherein, wheninflated, the first and second inflatable members are configured toreceive a wall of the urinary bladder therebetween to prevent motion ofthe second catheter with respect to the urinary bladder.
 20. The deviceof claim 16, wherein at least the flexible flat filter is configured tobe implanted in the subject's body between abdominal wall muscles and atransversalis fascia membrane of the subject's body.
 21. The device ofclaim 16, wherein the filter comprises a conduit for injection ofliquids into the filter, wherein the conduit is configured to extendexternal to the subject's body.
 22. An implantable renal replacementtherapy device, the device comprising: a first catheter configured to beinserted into a blood vessel in a subject's body; a pump in fluidcommunication with the first catheter, the pump is configured to pumpsubject's blood from the blood vessel; a filter in fluid communicationwith the pump, the filter is configured to: receive the subject's bloodfrom the pump, and filter the received blood to provide a filtered bloodand a filtrate liquid, wherein the filter is in fluid communication withthe first catheter to cause an outflow of the filtered blood from thefilter to the blood vessel; and a second catheter in fluid communicationwith the filter and configured to be inserted into a urinary bladder inthe subject's body to cause an outflow of the filtrate liquid from thefilter to the urinary bladder.